Chiropractic Clinical Care Topics



  Conditions: A-G    Conditions: H-O    Conditions: P-Z  
The following is a list of chiropractic clinical care topics covered at ChiroACCESS. Please use the links (topic names) to continue on to the clinical care topic's overview page. There you will find a list of current clinical reviews, articles, forms, media and other information relating to that topic.
Acute Juvenile Cervical Torticollis

Acute Juvenile Cervical Torticollis



Acute juvenile cervical torticollis is a descriptive term that encompasses several different diagnoses. Some of the causes of torticollis are life threatening or can lead to long term morbidity. A thorough examination is necessary to rule out serious pathology. The clinical reviews will primarily discuss the potentially serious condition atlantoaxial rotation fixation (AARF) and the relatively benign muscular torticollis (MT). Both conditions typically resolve quickly, however the physician must be aware if AARF is slow to respond to treatment possible serious sequela are possible. According to Roche et al if an AARF is detected and resolved within 1 month the prognosis is good and after 1 month it is guarded. Cervical fusion is recommended when there is neurological involvement, anterior displacement of C1 on C2, failure to achieve correction and presence of AARF for over 3 months (1).

(1) Roche CJ, O'Malley M, Dorgan JC, Carty HM. A pictorial review of atlanto-axial rotatory fixation: key points for the radiologist. Clin Radiol 2001 Dec;56(12):947-58.

Acute Whiplash Injuries

Acute Whiplash Injuries



There are several terms used to describe acute whiplash injury (AWI). Among them are acceleration-deceleration injury, hyperextension-hyperflexion injury, whiplash associated disorders just to name a few. Regardless of the description, the injury is caused by a rapid change in the position of the head which imparts energy transfer to the structures of the cervical spine, most commonly as a result of an automobile accident. A wide variety of symptoms may result to include cervical pain, headache, light headedness, tinnitus, jaw pain, or vision abnormalities. Long term symptoms are common (1).

Diagnosis of acute whiplash injury (AWI) is primarily based on history, examination and radiographic examination when necessary. The first concern to the physician is to determine the extent of injury to avoid interventions that may be harmful to the patient. Neurological and ligamentous injury resulting in laxity can result in negative outcomes if not recognized early in the intervention process. The following chart represents the commonly used standard of grading for AWI as developed by the Quebec Task Force (2):

GradeClinical Presentation
0No neck complaints, no physical signs
1Complaints of neck pain, stiffness or tenderness. No physical signs.
2neck complaint and musculoskeletal signs
3Neck complaint and neurological signs
4Neck complaint and fracture/dislocation

(1) Krakenes J, Kaale BR. Magnetic resonance imaging assessment of craniovertebral ligaments and membranes after whiplash trauma. Spine 2006; 31(24):2820-2826.; (2) Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine 1995; 20(8 Suppl):1S-73S.

Adolescent Idiopathic Scoliosis

Adolescent Idiopathic Scoliosis



Adolescent idiopathic scoliosis (AIS) is an exclusion diagnosis determined only after other known causes of scoliosis have been ruled out. It is defined as a lateral spinal curvature of greater than 10 degrees as measured by the Cobb method. Other characteristics are vertebral body rotation and onset after the age of 10.

The prevalence of AIS has been estimated at 2% (1). The prevalence of AIS requiring treatment is 2 to 3 in 1000 (2).

A total of 148 references were used in preparation of the prevention, diagnosis and treatment sections of the adolescent idiopathic scoliosis monographs.

(1) Greiner KA. Adolescent idiopathic scoliosis: radiologic decision-making. Am Fam Physician 2002; 65(9):1817-1822; (2) Bunnell WP. Selective screening for scoliosis. Clin Orthop Relat Res 2005;(434):40-45.

Asthma

Asthma



Asthma is a multifactorial disease that is not well understood and can have a variety of risk factors. In the United States it affects over 22 million people, results in 4000 deaths annually (1) and is responsible for 200,000 hospitalizations annually (2). Of additional concern is the observation that the number of asthma cases has doubled in the United States since 1980 (3). Considering the fact that standard asthma treatment protocols only address symptom reduction and do not resolve the condition, prevention is the most viable treatment option.

It is important to note the conclusions made by Saglani and Bush review of the origins of asthma. It was stated that "the roots of asthma are to be found in the first three years of life…By age 3, the die is cast and lung function tracks lifelong" (4).

(1) Balkissoon R. Asthma overview. Prim Care 2008 Mar;35(1):41-60, vi.; (2) Michael MA. Scope and impact of pediatric asthma. Nurse Pract 2002 Jun;Suppl:3-6.; (3) Redd SC. Asthma in the United States: burden and current theories. Environ Health Perspect 2002 Aug;110 Suppl 4:557-60.; (4) Saglani S, Bush A. The early-life origins of asthma. Curr Opin Allergy Clin Immunol 2007 Feb;7(1):83-90.

Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder



Attention deficit-hyperactivity disorder (ADHD) has been defined as "the inability to marshal and sustain attention, modulate activity level and moderate impulsive actions" (1). A commonly used diagnostic protocol for the primary care physician is the American Academy of Pediatrics (AAP) "Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder" (2). This guideline includes the following 6 recommendations:
RECOMMENDATION 1: In a child 6 to 12 years old who presents with inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems, primary care clinicians should initiate an evaluation for ADHD.

RECOMMENDATION 2: The diagnosis of ADHD requires that a child meet the Diagnostic and Statistical Manual of Mental health Disorders, Fourth Edition (DSM-IV) criteria.

RECOMMENDATION 3: The assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms, and degree of functional impairment.

RECOMMENDATION 4: The assessment of ADHD requires evidence directly obtained from the classroom teacher (or other school professional) regarding the core symptoms of ADHD, the duration of symptoms, the degree of functional impairment, and coexisting conditions. A physician should review any reports from a school-based multidisciplinary evaluation where they exist, which will include assessments from the teacher or other school-based professionals.
RECOMMENDATION 4A: Use of these scales is a clinical option when diagnosing children for ADHD.

RECOMMENDATION 4B: Use of teacher global questionnaires and rating scales is not recommended in the diagnosing of children for ADHD, although they may be useful for other purposes.
RECOMMENDATION 5: Evaluation of the child with ADHD should include assessment for coexisting conditions.

RECOMMENDATION 6: Other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD.

(1) Rappley MD. Clinical practice. Attention deficit-hyperactivity disorder. N Engl J Med 2005 Jan 13;352(2):165-73.

(2) Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. American Academy of Pediatrics. Pediatrics 2000 May;105(5):1158-70.

Biomechanical Sacroiliac Joint Pain

Biomechanical Sacroiliac Joint Pain



Biomechanical sacroiliac joint pain (BSJP) is closely related to biomechanical low back pain and differentiating between the two is difficult. Until 1934 the sacroiliac joint was considered the source of most low back pain. In 1934 the concept of the herniated disc as the primary low back pain was developed (1) and the sacroiliac joint was largely forgotten. However during the last decade the sacroiliac joint has again been recognized as a significant contributor to low back pain. Up to 27% of chronic low back pain may be attributed to the sacroiliac joint (2).

(1) Hansen HC, Helm S. Sacroiliac joint pain and dysfunction. Pain Physician 2003; 6(2):179-189.; (2) Hansen HC, McKenzie-Brown AM, Cohen SP, Swicegood JR, Colson JD, Manchikanti L. Sacroiliac joint interventions: a systematic review. Pain Physician 2007; 10(1):165-184.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome



Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it passes through the carpal tunnel of the hand. Symptoms include numbness, tingling or pain along the distribution of the median nerve with symptoms often more pronounced at night. This commonly encountered condition has a prevalence of 2.7% and is more common in older women.

Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282(2):153-158.

Cervicogenic Headache

Cervicogenic Headache



Cervicogenic headache (CH) was only recently recognized by the International Headache Society as a distinct headache diagnosis. It is described as pain originating in the structures of the cervical spine and characterized as a deep, non-throbbing, recurring headache. Its prevalence has been estimated to be as high as 16% of the population.(1)

(1) Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol 1991; 44(11):1147-1157

Dizziness of Cervical Origin

Dizziness of Cervical Origin



Cervicogenic vertigo (CV) remains a somewhat controversial diagnosis as some physicians do not recognize it as a clinical entity. Yet there is ample evidence to suggest altered afferent input from the neck can give rise to “altered orientation in space and disequilibrium” (1). Generally speaking any process that disrupts afferent input such as whiplash injury or cervical spondylosis can result in CV. Up to 58% of individuals with whiplash injury report dizziness (2).

(1) Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther 2000; 30(12):755-766.; (2) Reid SA, Rivett DA. Manual therapy treatment of cervicogenic dizziness: a systematic review. Man Ther 2005; 10(1):4-13.

Fibromyalgia

Fibromyalgia



Fibromyalgia is a common condition of uncertain etiology. It is characterized by widespread muscular pain, sleep disturbances, fatigue and presence of widespread tender points. Prevalence is estimated to be 3.4% for women and 0.5% for men (1). Treatment interventions are limited to essentially palliative care.

(1) Millea PJ, Holloway RL. Treating fibromyalgia. Am Fam Physician 2000; 62(7):1575-82, 1587.